The Black Market for Opioids

On Friday, June 22, 2018, the U.S. House of Representatives passed comprehensive, bipartisan legislation, H.R. 6, aimed at the opioid crisis. Representative Greg Walden described the combination of 58 bills as “one of the most significant congressional efforts against a drug crisis in our nation’s history.” Here in New Mexico, particularly in Rio Arriba, deaths from opioid overdose have become a daily occurrence, with one of the highest death rates in the Nation. Rio Arriba’s Wal-Mart is fighting the epidemic with a program called DisposeRx. This provides a safe, convenient, and permanent way of disposing leftover and expired opioids, and can prevent their abuse.

The New Mexico Prescription Monitoring Program (NM PMP) is an electronic database that aids in the collection and reporting of controlled substance prescriptions. Patients who receive prescriptions from multiple providers or pharmacies, are at high risk for overdose. Thus, an “alert” is tied to patient’s record, after opioids are dispensed from 6 different providers and pharmacies during a 5 month period. Our local law enforcement also has access to NM PMP, and can request reports when they are working on a case. The opioid crisis is straining the resources of local law enforcement, diverting time and money away from other priorities. Police officers are often on the front line in this war, forced to become social workers as they are the first responders to opioid related violence, petty crimes, and child neglect.

Although both programs are steps in the right direction, they do little to fight the illegal sale of opioids in our neighbourhoods and the internet: namely the Black Market. More than 50% of those who abuse opioids get them through friends or relatives, not a health care provider. There is a disturbing congressional report that suggests Medicaid fraud also drives the opioid crisis. Medicaid recipients access the opioids, then sell them on the black market for many thousands of dollars. A hospital administrator told me that blood work to detect the presence of opioids was an effective, but optional, measure to combat illicit opioid sales. Such a requirement could ensure that those who are given the prescription, especially those who are battling cancer and other chronic diseases, are using them. H.R. 6 does require state Medicaid programs to have safety edits in place for opioid refills and improves the monitoring of opioid prescriptions.

The problem with all government crackdowns, is that it drives the practice underground. Predictably, the U.S. Drug Enforcement Agency’s attempts to reduce the number of opioid prescriptions have resulted in a surge of “dark net” opioid sales, which are extremely difficult to regulate. In fact, more people are turning to internet to get their opioids, using software-encrypted, elusive online portals. H.R. 5483, included in H.R. 6, allows health care providers to prescribe opioids via telemedicine in legitimate emergency situations. However, it does not address the “dark net” of opioid sales.